Death Panels: An Obituary

As one of those groups, The Conversation Project with our partners at IHI, created a kit to make it easier for people to talk at the kitchen table with their loved ones before there is a crisis. It’s deliberately designed to talk more about values than medical procedures.

If the “death panel” furor heightened anxiety that “faceless bureaucrats” would make life and death decisions, these conversations are committed to exactly the opposite idea: people should be at the center, making their own decisions.

The belief in death panels didn’t just evaporate. Repeated polls taken after 2009 showed that, yes, as many as a third of people continued to believe that there were death panels in Obamacare which would decide whether to “pull the plug on granny.” And yet, at the same time, a much larger majority thought doctors should be paid for their time discussing end-of-life care — exactly the provision that was distorted into death panels.

An even larger majority thought people should talk about their own wishes. In a survey that The Conversation Project did, 90 percent said it was important to have these conversations. Since 90 percent of Americans don’t agree on anything—including the national anthem—that’s huge. Fewer than 30 percent have actually had these conversations. But we are at that turning point.

The signposts of cultural change? If this were BuzzFeed, I would offer a list of Top 10 Signs that have appeared over the past year or two. But this list will do for now:

In 2014, Atul Gawande’s book, “Being Mortal”—a book that the publishers thought was too grim to be released around Christmas—took off and stayed on the best-seller list for a year. “The Fault in Our Stars,” a movie about teenage death, made $48 million its first weekend. Brittany Maynard, a young woman with terminal brain cancer, provoked a national debate over her desire to end her own life with physician assistance. The American Medical Association came out in favor of reimbursing conversations between doctors and patients about end-of-life care. And the venerable Institute of Medicine published a seminal report on “Dying in America” that said, “advance care planning is essential to ensure that patients receive care reflecting their values, goals and preferences.”

Death panels were not just debunked; the fear-mongering around the topic has turned out to be on the wrong side of the everyday experience of families.

Culture warriors have misunderstood the public instincts on end-of-life care before. In 2005, in the dramatic struggle over Terri Schiavo’s fate, then-Governor Jeb Bush framed himself as her protector, taking sides against her husband. By last spring, the new Jeb told a New Hampshire crowd that “if you are going to mandate anything from government, it might be that if you’re going to take Medicare you also sign up for an advance directive where you talk about this before you’re so disabled.” Yo, Jeb—government mandates?

What now? The new Medicare rules will help encourage and normalize end-of-life conversations. Beginning Friday, doctors and other clinicians will be reimbursed for talking with all their patients—not just sick patients—about end-of-life care. Quietly, in one room after another, in 2016, a talk that almost derailed Obamacare in 2009, will become routine.

A modest payment of $80 or $86 is not in itself going to change the way of death in America. We still need to help clinicians become trained and comfortable as they talk about the D word. We need to be sure that when the time comes the health care system respects those treatment plans—indeed, can even find them.

More than anything else, these are not just conversations to have with providers; we need to have them with people we love, those who may have to decide for us. This is more than a code on a chart; it’s a gift.

But for the moment, when fact-checking seems like a thankless occupation, and Trump boasts that “Every time things get worse, I do better,” it sure does lift the spirit to deep-six one big fat lie. Death panels: May they rest in, well, peace.